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Multnomah County Board updated on efforts to improve mental health services in jail

November 17, 2017

The Multnomah County Board of Commissioners received an update Thursday on work either in place or in progress to improve mental health services inside the county’s jails.

The update was at the request of the Multnomah County Sheriff’s Office and the Multnomah County Corrections Health Division. It comes after three outside groups released audits, from different perspectives, critical of mental health services in the jail: the National Institute of Corrections, the County’s Corrections Grand Jury and Disability Rights Oregon.

“Each audit was a comprehensive effort involving a review of files, site visits, inspections and multi-disciplined interviews,” said Sheriff Michael Reese.

“We’re not afraid to take a hard look at ourselves. Our agency embraced the process and accepted each report before transitioning from an audit facilitation to recommendations.”

Seventy-five recommendations are either in effect or in the works to improve services at the Multnomah County Inverness Jail in Northeast Portland and the Multnomah County Detention Center in downtown Portland.

Sheriff Reese detailed changes in hiring, training and care in custody alongside changes in the physical jail environment and improvements made when an inmate is released.

In addition to commitments to hiring diverse staff, Reese described an inclusive process for developing new policies that now incorporates comment from the public, Sheriffs Office staff and key stakeholders.

All policies will run through this new process, Reese stressed, including policies that deal with how confrontation is managed and how deputies use of force.

This spring, 466 corrections staffers received training on a new curriculum based on crisis intervention that covered suicide prevention, de-escalation techniques and interactive training with an National Alliance on Mental Illness panel. An additional 450 corrections staffers received training in mental health and first aid this summer.

That training work, Reese said, has been the “key to success.”

Management of Adults in Custody

The audits have prompted changes in the management of adults before being booked in jail, while in jail and when released.

The sheriff was hopeful about programs designed to divert people engaged in low-level criminal behavior and struggling with mental illness or addiction away from jail and into services.

In April, the Homeless Outreach and Programs Engagement (HOPE) Team launched. In February, the Law Enforcement Assisted Diversion (LEAD) Program launched, along with the Unity Center, a 24-hour behavioral and mental health services facility for those experiencing a mental health crisis.

This month, criminal justice partners began a mental health diversion program that gives officers the discretion to divert someone, depending on their charge or behavior, to the Unity Center or Cascadia Behavioral Health Clinic. Once someone arrives at those facilities, a mental health professional can conduct an official assessment and provide care.

“The person who is being arrested has to consent to going to Cascadia and the exchange of information,” Reese explained in response to concerns about profiling.

“The District Attorney, when they see that a person has been connected to a mental health provider and that there’s been engagement, will likely dismiss the charges,” Reese continued. “So the District Attorney's Office has been a part of this process and has agreed that diversion is the appropriate response to people in crisis, not the criminal justice system.”

Inside the jail, Facility Services Manager Katie Burgard highlighted partnerships with important partners. The County’s Forensic Diversion Program works directly with inmates who may not be able to aid and assist in their own defense and helps them with legal skills. The Forensic team also works with the Sheriff’s Pretrial Release Program “Closed-Street Supervision”’ to provide wraparound services for people who might not be successful in a traditional pretrial release program.

“It’s really important to remember that this is jail, and there’s only so much we can do in correctional environment,” explained corrections deputy Sgt. Amie Banta in the video. “We certainly can’t take the doors off and we can’t compromise the safety and security of the facility. But there are some physical changes that we can make to the design of the unit to help inmates feel like they are in less of an institutional environment and a more therapeutic environment.”

Care in custody

In partnership with Corrections Health, the Sheriff’s Office formed a team to improve mental health services and provide comprehensive case management, Reese said.

The team includes:

a focused mental health sergeant and utility deputy who help coordinate medical and mental health care

a board-certified forensic psychiatrist

mental health nurse practitioners

a mental health manager who will provide expert oversight and input on policies, procedures and practices

“We are in the process of recruiting two additional mental health consultants, which the commissioners allowed us to have in the budget this year,” said Dr. Michael Seale, Corrections Medical Director.

“They would be on our swing shifts, which tends to be very busy in the jail, to allow for seven-day-a-week coverage of a mental health consultant,” Seale said. The consultants would also provide guidance to nurses in the reception area and be available for people released on their own recognizance who need guidance.

An extra deputy at both the Inverness Jail and the downtown detention center has meant expanded hours at jail clinics and allowed detainees to interact with professionals in a more clinical setting.

Mental health consultants are now involved in disciplinary issues to help re-evaluate disciplinary action. Inmates in the jail system’s mental health housing are reviewed weekly.

“We’re not only seeing quantity of care improving, but quality of care improving,” said Seale.

What happens at release

“We continue to provide professional access to all service providers in the community,” said Burgard when addressing what happens when inmates are released into the community.

“It’s very important to the Sheriff’s Office that individuals in our facility still maintain connections to their providers from their community and any existing resources they have.”

Burgard said release services may also include individualized discharge plans, training in personal growth, education, job and legal skills, and help with health insurance.

A health care eligibility specialist meets with people newly booked into jail to check whether they have insurance or are eligible for the Oregon Health Plan. The specialist can activate the plan when a person leaves the facility.

“It’s exciting to see you making these small changes that have a big impact,” said Commissioner Lori Stegmann.

“I’m most concerned about how we discharge people and the warm hand-off,” Stegmann continued. “If we really want to rehabilitate people, there has to be more of a seamless handover for folks to receive continued services.”

“I will be looking forward to some kind of coordination between our jails and prison systems.”

Challenges

While the changes mark progress in mental health services Sheriff Reese stressed it is just the beginning.

“We’ve worked hard to improve capacity for people in a mental health crisis. But finding people and training them for the difficult work we ask them to do is a shared challenge.”

Reese described the job market as an issue. Managing the facilities themselves and inmates’ short stays in jail also present challenges.

“It may seem counter-intuitive,” said Reese. “But with our folks turning over so quickly it’s challenging for corrections health and other partners to have a meaningful impact on that person while they’re in our custody. Some of our folks are out in just a few days and we’re not able to get them stabilized or hooked up with community partners. Not that we want to change that, but it is one of the challenges.”

Commissioner Meieran commended the progress but inquired about tools used in restraint situations like: restraint chairs and handcuffs.

We’re currently reviewing restraint policies replied Reese. A draft of the policy will be presented to the board.

“It’s a challenging one,” said Reese.

“Some people engage in self-harm but we want to do that in a manner that is in alignment with corrections health and getting the person transported to a hospital so they are not staying simply staying our custody when they really should be hospitalized for that behavior.”

The goal for those released from our jail is to ensure that everyone has a plan, Reese said.